Lateral Excursion Research Articles

A novel Movement Amplification environment reveals effects of controlling lateral centre of mass motion on gait stability and metabolic cost.

During human walking, the centre of mass (COM) laterally oscillates, regularly transitioning its position above the two alternating support limbs. To maintain upright forward-directed walking, lateral COM excursion should remain within the base of support, on average. As necessary, humans can modify COM motion through various methods, including foot placement. How the nervous system controls these oscillations and the costs associated with control are not fully understood. To examine how lateral COM motions are controlled, healthy participants walked in a ‘Movement Amplification’ force field that increased lateral COM momentum in a manner dependent on the participant's own motion (forces were applied to the pelvis proportional to and in the same direction as lateral COM velocity). We hypothesized that metabolic cost to control lateral COM motion would increase with the gain of the field. In the Movement Amplification field, participants were significantly less stable than during baseline walking. Stability significantly decreased as the field gain increased. Participants also modified gait patterns, including increasing step width, which increased the metabolic cost of transport as the field gain increased. These results support previous research suggesting that humans modulate foot placement to control lateral COM motion, incurring a metabolic cost.

Right ventricular speckle tracking analysis in patients with mitral stenosis

The 2D-speckle tracking is a new echocardiographic tool to have an objective and angle-independent quantification of myocardial deformation. Recent developments were performed for the quantification of longitudinal dynamic right ventricular deformation. We aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. Fifty patients with rheumatic mitral stenosis (MS group) and 20 control healthy patients were recruited and had had standard echocardiography and Doppler echocardiography. The right ventricular functions were determined by conventional methods and two-dimensional (2D) longitudinal strain. There were no significant differences in age, sex, Body mass index and Left ventricular ejection fraction. Mitral valve area in MS group (1.38 ± 0.5 cm vs. 3 ± 0 cm), left atrial surface (31.68 ± 8.5 cm 2 vs. 13.5 ± 1.4 cm 2 ), and Pulmonary systolic arterial pression (44.64 ± 12.4 mmHg vs. 22.7 ± 2.7 mmHg) were higher in MS group. Conventional echocardiographic modalities of RV function were analysed: Peak systolic velocity at the lateral tricuspid annulus (S’: 12.24 ± 2.8 cm/s vs. 18.6 ± 1 cm/s) and tricuspid annular systolic excursion (TAPSE) were lower in MS group (18.7 ± 4.07 vs. 26.7 ± 0.7). Two-dimensional longitudinal strain was significantly decreased in MS group (−14.1 ± 4.2 vs. −19.3 ± 1.6) and was correlated to mitral valve area ( P = 0.03). There was a correlation between conventional methods (S’ and TAPSE) and RV-strain (RV-strain- S’: P = 0.001; RV strain-TAPSE: P = 0.01). We demonstrated that patients with MS had lower RV functions using 2D strain imaging. 2D strain imaging appears to be useful in the detection of subclinical RV dysfunction in patients with MS.

An exploration of the differences in hip strength, gluteus medius activity, and trunk, pelvis, and lower-limb biomechanics during different functional tasks

ABSTRACT The purpose of the study was to explore differences in the coronal biomechanics of the trunk, pelvis, hip, and knee joints, and gluteus medius muscle activity (GMed) during walking and step down from two riser heights. Joint kinematics and kinetics from 20 healthy participants were recorded using a 10-camera Qualisys system and force plates, and GMed EMG was recorded using a Delsys Trigno system. Hip abductor strength was measured using a hand-held dynamometer. Pelvic obliquity and lateral trunk bending excursions were significantly higher in walking than in step-down tasks. Significantly greater knee adduction moments were seen during both step-down tasks compared to level walking with significantly greater GMed activity. However, a significant interaction between side and task was seen for hip adduction moment, with step-down tasks showing lower hip moments than during walking, with greater peak hip moments being more apparent in the dominant limb. This suggests the GMed has a greater stabilizing role during the step-down tasks, although walking required a greater mechanical demand. Health professionals should expect to find less excursion of lateral trunk bending in step-down tasks compared to level walking and consider that GMed has different roles in these two tasks.

05 Shoe Insole Intervention to Reduce Falls and Injuries

Abstract Despite a number of strategies to minimise falls risks, older adults tend to avoid voluntary and continuous engagement into interventions without cost effectiveness and simplicity. Shoe-insole modification may be a practical intervention if it alters foot geometry inside a shoe and improves gait patterns to prevent falls. The current study designed a shoe-insole structure with 2.2 dorsiflexion and 4.5 eversion built-in inclinations on the entire insole surface. Ankle dorsiflexion is fundamental for higher swing foot clearance to reduce tripping falls. Eversion support may also regulate excessive lateral foot centre of pressure (CoP) excursion to prevent ankle sprain and associated falls. Three young male participants (Age: 21 ± 3 yrs., Height: 1.70 ±.08m, Body Mass: 65.3 ± 2.65kg) conducted gait testing on an 8m walkway repeatedly to collect 60 step cycles for both non-insole and insole conditions. Optotrak motion capture system (NDI) recorded swing foot clearance at 100 Hz while AMTI force plates obtained ground reaction forces data, therefore CoP movements. Minimum foot clearance (MFC) was defined as the local minimum vertical toe-ground clearance during mid-swing, where higher MFC prevents tripping falls. The tested insole increased MFC by .20cm on average, considered to effectively reduce tripping falls. Lateral CoP excursion (lateral displacement from initial CoP location at heel contact to the most lateral CoP location during the initial phase of loading response) was reduced by 1.18cm (61%) due to insole walking, possibly indicating the lower risk of ankle sprain and sideways balance loss. Despite these positive effects, further validation is necessary with a sufficient sample size including the older population. It is also essential to consider negative aspects of continuous dorsiflexion and eversion support. For example, the tested insole may disturb functionally important supination. Prior to practical use, human trials for a prolonged period of time are required for insole intervention.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

Changes in mandibular and articular dynamics associated with surgical versus nonsurgical treatment of mandibular condylar fractures: a systematic review with meta-analysis.

The aim of this study was to evaluate the mandibular and articular dynamics and the presence of complications associated with surgical or nonsurgical treatments of condylar fractures. Clinical trials that compared open reduction internal fixation and maxillomandibular fixation in patients with condylar fractures were included. We performed an electronic search of PubMed, Scopus, Cochrane Library, Web of Science, and LILACS (Latin American and Caribbean Health Sciences) databases starting from February 2017 and updated in January 2019 and found 467 articles. We evaluated methodologic quality by using the criteria from Cochrane's Collaboration Tool. After independent screening of abstracts, we assessed the full texts of 88 articles; 9 studies were included for qualitative synthesis; but only 8 were included for the meta-analysis. Four studies were considered to have high risk of bias, and 5 were considered to have low risk. The risk ratio (RR=0.20; 95% confidence interval [CI] 0.13-0.32) was observed for complications. The quality of evidence, using GRADE software, was considered low for maximum mouth opening and protrusive movement and moderate for lateral excursion movement and complications. This review suggested that open reduction internal fixation and maxillomandibular fixation are effective. However, surgical treatment presented higher objective parameters. Nonsurgical treatment presented a high index of complications, such as malocclusion, pain and deviation.

Evaluation of Disclusion Time in Various Angle's Malocclusions by T-Scan III System.

Objective The main purpose of this article is to evaluate the disclusion time (DT) in the lateral excursions and protrusion among subjects with Angle’s malocclusions using a T-Scan III system. Materials and Methods One hundred subjects with malocclusions were divided into Class I, Class II division 1, Class II division 2, and Class III ( n = 25 per group). All groups’ DT of each excursion was evaluated by a T-Scan III system. Statistical Analysis One-way analysis of variance, followed by a post hoc test, was used to analyze the numerical data at p < 0.05. Results In the respective malocclusions, means ± standard deviations in second(s) of the DT were 2.08 ± 0.65, 2.13 ± 0.74, 2.12 ± 0.72, and 3.19 ± 1.34 during left excursion; 2.15 ± 0.94, 2.58 ± 1.16, 2.37 ± 1.07, and 3.28 ± 1.25 during right excursion; and 1.88 ± 0.99, 2.08 ± 1.11, 2.07 ± 0.68, and 3.01 ± 1.53 during protrusion. When compared to Class I and Class II malocclusions, Class III showed a significantly higher mean DT of each excursion ( p < 0.05). Conclusion Class III had the significantly highest mean DT of each excursion and the significantly longest DT in all excursions.

P2602Inhaled iloprost improves echocardiographic myocardial performance during exercise in heart failure with preserved ejection fraction

Abstract Introduction The pathophysiology of HFpEF is complicated and treatments that improve outcomes in HFrEF have no substantial benefits in HFpEF. Impairments in LV global longitudinal strain (GLS) and LV diastolic function parameters have been regarded as novel echocardiographic markers to predict cardiovascular events in HFpEF. Preliminary trials indicate that iloprost, an inhaled prostacyclin analougue, improves exercise hemodynamics in both patients with pulmonary artery hypertension and pulmonary hypertension associated with HFpEF. Purpose We aim to investigate the impact of inhaled iloprost on LV global longitudinal strain, LV diastolic function and RV function during exercise in HFpEF population. Methods 34 patients diagnosed with HFpEF were included with exclusion of severe pulmonary, coronary artery, valvular heart and pericardial diseases. Subjects were randomized 1:1 to inhalation of iloprost or placebo. Transthoracic echocardiography was performed at rest and after 6-minute supine bicycle exercise at 20-Watt workload. We utilized tissue speckle tracking by QLAB software to derive LV GLS and global strain rate during LV isovolumetric relaxation period (SRIVR). E/e', E/SRIVR, tricuspid regurgitation pressure gradient (TRPG), tissue Doppler imaging of RV lateral tricuspid annulus and tricuspid annular plane systolic excursion (TAPSE) were measured to evaluate changes of myocardial performance. Results LV GLS during exercise significantly enhanced after iloprost use. E/SRIVR, a novel predictor of LV filling pressure, was significantly decreased. E/e' was also lower in iloprost group by trend. Improvements in RV function and degree of pulmonary hypertension during exercise with iloprost were observed in this study. Echocardiographic myocardial function endpoints during 20-Watt excercise between iloprost and placebo groups Iloprost (N=17) Placebo (N=17) P value LV global longitudinal strain, % −4.96±1.20 −0.75±3.00 &lt;0.001 E/SRIVR, cm 206.41±113.55 454.13±262.98 0.005 E/e' mean 10.77±2.39 14.41±12.14 0.235 TAPSE, cm 2.62±0.62 2.37±0.56 0.221 TRPG, mmHg 28.37±12.47 44.25±9.29 &lt;0.001 TDI lateral tricuspid annulus, cm/s 16.41±4.61 14.77±2.92 0.222 Effects of iloprost at rest and exercise Conclusions Our study is the first to demonstrate that, in patients with HFpEF, inhaled iloprost favorably enhances LV GLS reserves, decreases LV diastolic filling load, reduces pulmonary hypertension and thereby improves RV function during exercise. Acknowledgement/Funding This work was supported in part by the National Science Council of the Republic of China, Taiwan (NSC107-2314-B-002-265-MY3)

Effectiveness of center-mounted airbag in far-side impacts based on THOR sled tests

Objective: The study aimed to evaluate the protection offered by a center-mounted airbag in far-side impacts using the Test device for Human Occupant Restraint (THOR) anthropometric test device (ATD).Methods: A rigid buck was designed based on a production vehicle. The buck consisted of a rigid seat, center console, dash, and far-side door structure. The center console and dash were covered with paper honeycomb (152 kPa), and the far-side door structure was covered with Ethafoam 220 padding material. The airbag was mounted on the seat, to the right of the occupant. The THOR-M50 ATD was positioned according to the standard seating procedure and restrained using a standard 3-point seat belt with a pretensioner and retractor. The buck was mounted on an acceleration sled in 2 orientations. Four tests at 45° (oblique) and 2 tests at 90° (lateral) orientations were conducted. Tests were performed with and without an airbag at 30 km/h delta-V and 14 g acceleration. The head accelerations, neck forces and moments, thoracic accelerations and forces, pelvis accelerations, anterior superior iliac spine (ASIS) forces and moments, and belt webbing loads were obtained from sensors, and the external kinematics was obtained using an optical motion capture system and high-speed digital cameras.Results: With the center-mounted airbag, in 90° and 45° tests, reductions were observed for the following parameters: head lateral excursions by 6% and 11%, head vertical excursions by 19% and 26%, and peak head resultant accelerations by 36% and 11%. Other regional accelerations, forces, and moments were also reduced for both impact angles. A reduction in seat belt forces with the airbag was observed in 90° tests.Conclusion: The center-mounted airbag reduced the ATD excursions and accelerations in the 45° and 90° tests, thus reducing the risk of injury due to contact with the intruding structure. The results of this study may assist in designing countermeasures for vehicles in far-side impact.

Sternoclavicular Graft Versus Costochondral Graft In Reconstruction of Ankylosed Temporomandibular Joint.

The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.

Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

BackgroundThere is controversy regarding the superiority of posterior-stabilizing (PS) total knee arthroplasty (TKA) and cruciate-retaining (CR) TKA. Substantial work has made comparisons between PS and CR TKA at follow-ups of less than 5 years. It was the goal of the present study to compare the kinematics at greater than 5 years postoperatively between CR and PS TKA, with a secondary goal of comparing patient function. MethodsA total of 42 knees were investigated, with equal representation in the PS and CR TKA groups. Patients underwent radiostereometric analysis imaging at 0°, 20°, 40°, 60° 80°, and 100° of flexion. Contact position, magnitude of excursion, and condylar separation on each condyle were measured. A Timed-Up-and-Go functional test was also performed by patients, with the total test time being measured. Preoperative and postoperative clinical outcome scores were also collected. ResultsThere were differences in contact position on both the medial and lateral condyles at multiple angles of flexion (P < .05). There was no difference (P = .89) in medial excursion; however, PS TKA had greater lateral excursion than CR TKA (P < .01). No difference (P > .99) was found in frequency of condylar separation. PS TKA was associated with faster (P = .03) total Timed-Up-and-Go test times. There were no differences in clinical outcome scores between the groups preoperatively or postoperatively. ConclusionWe found kinematic and functional differences that favor PS TKA. Our results suggest posterior cruciate ligament insufficiency in CR TKA, indicating that perhaps the cam/post systems in PS TKA better maintain knee kinematics and function long term.

Reproducibility of a three-dimensional jaw model during opening and lateral excursion tests

The paper presents results of numerical investigations of annular non–swirling jets. The research is performed with the use of large eddy simulations (LES) and a high–order code based on the compact differences and the Fourier approximation combined with a projection method for pressure–velocity coupling. We consider various Reynolds numbers and inner shear layer thicknesses and observe that both parameters affect the dynamics of the flow in such a way that the formation of the turbulent structures follows two different scenarios. For the particular group of the inlet conditions the flow pattern is found to be similar to low–swirling jets. The instantaneous flow–fields reveal the formation of the spiral structures located in the inner and outer mixing layers. The analysis shows that the structures are the result of the instability that leads to the precession of the recirculation region formed in the near–field. The winding sense of the spirals are clockwise or counterclockwise depending on the case and azimuthal distribution of perturbations.

Exclusive Functional Treatment for Mandibular Condylar Fractures

Despite the frequency of condylar fractures, no consensus has been reached regarding treatment alternatives (ie, operative vs nonoperative). The purpose of the present study was to describe functional treatment without intermaxillary fixation of condylar fractures and summarize the treatment outcomes. We designed a retrospective case series and enrolled patients with condylar fractures with malocclusion. The primary outcome was treatment success, assessed at the end of 6weeks. We recorded 5 parameters to assess treatment success, including a stable return to the initial occlusion, lateral excursion of more than 7mm, centered protrusion of more than 4mm, centered mouth opening of more than 35mm, and painless mandibular mobilization. If all 5 parameters were met, treatment was deemed a success. Treatment failure was defined as meeting less than all 5 parameters. We used numbers and percentages for these nominal qualitative variables (healing criterion absent or present). Two prognostic variables (ie, fracture type and age range), stratified by treatment success, were compared using the Fisher exact test for patients presenting with all healing criteria. We included 30 patients with a median age of 33years. Of the 30 patients (34 fractures), 15 had low subcondylar fractures (44.1%), 12 had high subcondylar fractures (35.3%), and 7 had head condylar fractures (20.5%). At the last consultation, 21 patients (70%) had exhibited all the criteria defining treatment success. A significant difference was found in the success rate when stratified by age (P=.002) in favor of the younger patients. Also, high subcondylar and head fractures were associated with a better success rate. Exclusive functional treatment showed promising results and should be considered for cooperative patients, avoiding the risks of surgery and the discomfort with intermaxillary fixation.

Computerized ultrasonic axiographic evaluation of condylar movement in patients with internal derangement of the temporomandibular joint.

To evaluate condylar movement during lateral excursion in individuals with internal derangement of the temporomandibular joint (TMJ) using ultrasonic axiography. A total of 34 patients with internal derangement of the TMJ and 34 participants in the control group were examined. Mandibular functional movement was recorded by ultrasonic axiography. Three-dimensional condylar movement was measured in the working and balancing condyles. Significant differences in condylar movement were found between the two groups. In the group with internal derangement of the TMJ, the three-dimensional linear distances of the condylar path in a working condyle were greater than in the control group during lateral excursion. The speed of the balancing condyle in the returning path of lateral excursion was significantly greater in the group with internal derangement than in the control group. The results of the present study indicate that internal derangement of TMJ may affect the working and balancing condylar movements during lateral excursion.

Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile

To determine whether abnormal global, transverse, and longitudinal ventricular contractility of the heart in fetuses with an estimated fetal weight <10th centile is present, irrespective of Doppler studies of the umbilical artery and cerebroplacental ratio. This was a retrospective study of 50 fetuses with an estimated fetal weight <10th centile that were classified based on Doppler results from the pulsatility indices of the umbilical artery and middle cerebral artery, and the calculated cerebroplacental ratio (pulsatility indices of the umbilical artery/middle cerebral artery). Right and left ventricular measurements were categorized into 3 groups: (1) global ventricular contractility (fractional area change), (2) transverse ventricular contractility (24-segment transverse fractional shortening), and (3) basal-apical longitudinal contractility (longitudinal strain, longitudinal displacement fractional shortening, and basal lateral and septal wall annular plane systolic excursion). Z scores for the above measurements were computed for fetuses with an estimated fetal weight <10th centile using the mean and standard deviation derived from normal controls. Ventricular contractility measurements were considered abnormal if their Z score values were <5th centile (z score <-1.65) or >95th centile (Z score >1.65), depending on the specific ventricular measurement. The average gestational age at the time of the examination was 32 weeks 4 days (standard deviation 3 weeks 4 days). None of the 50 study fetuses demonstrated absent or reverse flow of the umbilical artery Doppler waveform. Eighty-eight percent (44/50) of fetuses had one or more abnormal measurements of cardiac contractility of 1 or both ventricles. Analysis of right ventricular contractility demonstrated 78% (39/50) to have 1 or more abnormal measurements, which were grouped as follows: global contractility 38% (19/50), transverse contractility 66% (33/50); and longitudinal contractility 48% (24/50). Analysis of left ventricular contractility demonstrated 1 or more abnormal measurements in 58% (29/50) that were grouped as follows: global contractility 38% (19/50); transverse contractility 40% (20/50); and longitudinal contractility 40% (20/50). Of the 50 study fetuses, 25 had normal pulsatility index of the umbilical artery and cerebroplacental ratios, 80% of whom had 1 or more abnormalities of right ventricular contractility and 56% of whom had 1 or more abnormalities of left ventricular contractility. Abnormal ventricular contractility for these fetuses was present in all 3 groups of measurements; global, transverse, and longitudinal. Those with an isolated abnormal pulsatility index of the umbilical artery (n=11) had abnormalities of transverse contractility of the right ventricular and global contractility in the left ventricle. When an isolated cerebroplacental ratio abnormality was present, the right ventricle demonstrated abnormal global, transverse, and longitudinal contractility, with the left ventricle only demonstrating abnormalities in transverse contractility. When both the pulsatility index of the umbilical artery and cerebroplacental ratio were abnormal (3/50), transverse and longitudinal contractility measurements were abnormal for both ventricles, as well as abnormal global contractility of the left ventricle. High rates of abnormal ventricular contractility were present in fetuses with an estimated fetal weight <10th centile, irrespective of the Doppler findings of the pulsatility index of the umbilical artery, and/or cerebroplacental ratio. Abnormalities of ventricular contractility were more prevalent in transverse measurements than global or longitudinal measurements. Abnormal transverse contractility was more common in the right than the left ventricle. Fetuses with estimated fetal weight less than the 10th centile may be considered to undergo assessment of ventricular contractility, even when Doppler measurements of the pulsatility index of the umbilical artery, and cerebroplacental ratio are normal.

Unilateral mandibular condylar process fractures: a retrospective clinical comparison of open versus closed treatment.

To retrospectively compare the clinical outcomes of closed treatment (closed reduction and intermaxillary fixation) with open treatment (open reduction and internal fixation with miniplates and screws) of unilateral mandibular condylar process fractures. Adult patients with unilateral condylar fractures treated from January 2011 to July 2013 in the Oral and Maxillofacial Surgery Service at the Base Hospitalof the Federal District, Brazil, were invited to participate. Those who agreed to participate were scheduled for clinical evaluation, which consisted of a subjective questionnaire (completed by the examiner) and an objective physical examination of the temporomandibular joints and mandibular range of motion. The following variables were analyzed: mouth opening; lateral excursions of the mandible; presence of clicking; mandibular function impairment (speech, chewing); and occlusion. Seventeen patients (15 men and 2 women) attended the scheduled appointment: 9 had received open treatment (surgical) and 8 had received closed treatment (nonsurgical). Patients were evaluated at 6-30months postoperatively. Only maximum mouth opening (p = 0.044) and maximum lateral excursion to the unaffected side (p = 0.030) showed a significant difference between the closed and open treatment groups. Our findings are consistent with those reported in the literature as both methods (closed and open treatment) produced satisfactory outcomes. The only between-group difference was the amount of maximum mouth opening and lateral excursion to the unaffected side. Further randomized studies with a larger number of patients with condylar process fractures are needed to verify the results obtained with each treatment.

Lumbar Stability in Healthy Individuals and Low Back Pain Patients Quantified by Wall Plank-and-Roll Test.

Low back pain (LBP) has been linked to the degree of lumbar stability, but evaluating lumbar stability has remained a challenge. Previous research has shown that inertial sensors could be used to quantify motor patterns during the wall plank-and-roll (WPR) test, and that LBP may cause deviations in movement from the general motor patterns observed in healthy individuals. To generalize the lumbar motor patterns during the WPR test in healthy individuals, and to analyze the effect of aging and LBP on the motor patterns during the WPR test. A descriptive, exploratory research with a convenience sample. This study is registered at the Clinical Research Information Service (Korea) under public trial registration numbers KCT0002481 and KCT0002533. A biomechanics laboratory of a tertiary university hospital. 57 healthy individuals (23 men 36.7 ± 15.4 years old and 34 women 42.4 ± 17.7 years old) and 17 patients (5 men 48.4 ± 10.9 years old and 12 women 33.7 ± 9.9 years old) with axial LBP. Participants performed the WPR test with 2 inertial sensors placed on the thoracic spine and sacrum. Relative angles between the sensors were calculated to quantify and examine lumbar motion in 3 anatomical planes: axial twist, kyphosis-lordosis, and lateral bending. General motor patterns during the WPR test in healthy participants were examined, stratified based on age, and changes based on age were analyzed. Motor patterns of LBP patients were compared with those from the healthy group. Movement in the kyphosis-lordosis and lateral bending axes showed little variation in healthy participants, whereas in the axial twist axis there were 2 dominant patterns. A χ 2 test revealed that the distributions of 2 motor patterns in the axial twist axis between the younger group and the older group were significantly different (P < .05). Furthermore, the older group had decreased lordosis at the static position (P = .02) and at the maximal rotating position (P = .03). Compared with the healthy group, LBP patients showed increasing lateral bending at the maximal rotating position (P = .007) and increased lateral bending excursion angle (P = .04) during the WPR test. A general lumbar motor pattern was observed during the WPR test in the healthy participants, but age contributed to variations in this general pattern. Comparison of motor patterns between healthy individuals and LBP patients revealed a different type of variation in the LBP patients. The results presented should be scrutinized with further research, characterizing specific variations in different subgroups of LBP patients. III.

Effect of Temporomandibular Joint Mobilization on Neck Pain and Function in Patients with Chronic Non-Specific Neck Pain

Background. Neck pain is a common problem, and it includes 30% of 25–29 year olds. The percentage of people over 45 years of age has risen to 50% (Knight and Draper, 2012). Long-term muscle imbalance disrupts body biomechanics. Due to long-lasting pain, the quality of work may decrease, rest can get worse, and mood may change. Purpose. To determine the effect of temporomandibular joint mobilization for neck pain and function in patients who suffer chronic non-specifc neck pain. Methods. The study involved six people with non-specifc chronic neck pain, who were divided into two groups: exercises, and the second group – exercises and mobilization of temporomandibular joint. At the beginning and end of the study, we performed the following tests: deep neck flexor endurance test, visual analogue scale (VAS), goniometry, the amplitude of the temporomandibular joint. Results. In the group of exercises, the pain score after treatment decreased (before – 67 ± 28, after – 14 ± 16.5) the strength and endurance of the deep neck flexor muscle improved (before – 13.7 ± 2.5 s, after – 28.7 ± 6.4 s). The amplitude of all neck movements was improved (p &lt; 0.05), comparing them before and after physiotherapy. The amplitude of the temporomandibular joint improved the movement characteristics: depression, lateral excursions to left and right, protrusion (p &lt; 0.05). Conclusions. Comparing the results after applying different methods of physiotherapy, intensity of pain and neck function parameters did not show significant differences.Keywords: temporomandibular joint, nonspecifc neck pain, mobilization.

Evaluation of the Effect of Bioresorbable Plates and Screws in the Treatment of Condylar Fractures, Assisted by Digital Preoperative Planning

Although bioresorbable materials have begun to be applied in the clinic, they are used primarily in children with fractures; thus, there are few reports of their application for treatment of condylar fractures. This study evaluated the effect of the application of bioresorbable plates and screws for patients with condylar fractures, assisted by digital preoperative planning. This was a prospective interventional study. The sample was composed of 46 patients treated at the School of Stomatology of the China Medical University (Shenyang, China) from October 2016 through May 2018 for condylar fractures alone or in combination with other facial fractures. All patients underwent confirmatory preoperative computed tomography (CT) to obtain Digital Imaging and Communications in Medicine (DICOM) format data for preoperative designing. By digital designing, the authors confirmed operative plans for each patient. All 46 patients underwent bioresorbable osteosynthesis and underwent repeat CT on postoperative day 3. Postoperative clinical assessments included postoperative positions of the fracture segments, maximal mouth opening, lateral excursion movements, occlusal status, and patient satisfaction. These variables were used to assess postoperative efficacy. The sample was composed of 46 patients who had open reduction with internal fixation on 52 sides. At the 3-month follow-up visit, the proportions of patients who were satisfied with the results and who achieved stable occlusion, appropriate maximal mouth opening, and flexible lateral excursion movement were 97, 100, 66, and 95%, respectively. One patient sustained postoperative displacement of a condylar fracture fragment, as confirmed by repeated CT. He was lost to follow-up at 3months postoperatively. The results of this study suggest that open reduction treatment of condylar fractures implanted with bioresorbable materials in combination with digital preoperative designing is an effective method for managing patients in clinical practice.

The left ventricle in atrial septal defect: Looking through 3D glasses.

To identify left ventricular (LV) dyssynchrony and associated factors in atrial septal defect (ASD) patients, using real time three-dimensional echocardiogram (RT3DE). Left ventricular dysfunction has been observed in ASD. Few studies have utilized RT3DE to assess LV wall-motion abnormality in ASD. Patients aged ≥1year with ASD, with or without partial anomalous pulmonary venous drainage (PAPVD), were included over 1year. Additional cardiac defects or abnormalities independently affecting LV function were excluded. 2DE and RT3DE-derived LV function data were recorded. Student's t test and Pearson's correlation were used for analysis. Of 104 patients (69 females) aged 1-57years, ostium secundum ASD was present in 97 and sinus venosus ASD in 7. Maximum excursion increased significantly with age, weight, and body surface area (P<0.001). Majority of children (58%) aged 3-5years showed no delay in segmental excursion. Lateral wall excursional delay was greater beyond 5years or with weight>15kg (42% as compared to 20% in <15kg). In patients weighing<15kg, time to minimum systolic volume (Tmsv 16-SD) was higher with PAPVD and with indexed defect size>40mm/m2 , though not statistically significant. As compared to EF estimation by 2DE, EF derived using RT3DE was significantly lower (P<0.001). Left ventricular dyssynchrony is least between 3 and 5years. Beyond 5years, delayed lateral wall excursion is seen. With an indexed defect size exceeding 40mm/m2 , and in the presence of PAPVD, time to minimum systolic volume is higher.